Sex Differences in Stroke Risk Factors and Mechanisms in a Multi-Ethnic Asian Population

Previous studies have reported sex differences in stroke. There are few Asian studies. This study was performed to investigate sex differences in stroke risk factors and mechanisms in a multi-ethnic Asian population.

Data on patients admitted to Raffles Hospital for stroke were analysed. Data were extracted on sex, age, hypertension, diabetes mellitus (DM), hyperlipidaemia, smoking, heart disease, and prior cerebrovascular events (pCeVD). Stroke was subtyped into haemorrhagic stroke (HS) or ischaemic stroke (IS) based on brain scan. IS mechanism was categorised using Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, while the clinical syndrome by Oxfordshire Community Stroke Project (OCSP) classification.

Data were collected on 1165 patients, mean age 65.6 ± 12.9 yr; 47.4% female, 83.0% Chinese, with hypertension (63.5%) and hyperlipidaemia (60.3%) being the most common risk factors. HS comprised 23.5%. On regression analysis, compared to males, females had older age (OR 1.03, 95%CI 1.02-10.4) and DM (OR 1.60, 95%CI 1.11-2.30), but less smoking (OR 0.09, 95%CI 0.07-0.13), pCeVD (OR 0.67, 95%CI 0.49-0.93), and HS (OR 0.71, 95%CI 0.51-0.98). There were no differences in HS mechanisms, or IS mechanisms or syndromes. Sex-ethnic differences were found (p < 0.001), with more Chinese and fewer Indians among females compared to males.

This study corroborates previous studies of significantly older age and more diabetes mellitus, but less smoking and haemorrhagic stroke among female stroke patients compared to males; differences in HS and IS mechanisms were not found. Novel in this study is that sex-ethnicity differences were found. Future studies should prospectively validate these sex/ethnic differences.